29-380 (2) VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT !/C �?A 4b
USE
10 FRONT YARD " /�
SIDE YARD XJ7eJ SIDE YARD
REAR YARD
NOTES
IX. SITE OR PLOT PLAN — For Applicant Use
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BOCA FORM APEBP — 669 C1969 BUILDING OFFICIALS & CODE ADMINISTRATORS INTERNATIONAL, INC.
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, city, and State ZIP code Tel. No.
Owner or
Lessee
Builder's (I
2. License No.
Contractor aa
3.
Architect or
Engineer
I hereby certify that the proposed work is authorized by the owner of record and that I have been authorized by the owner to
make this application as his authorized agent and we agree to conform to all applicable laws of this jurisdiction.
Signat re of applicant Address Appliccaa/tiioonn date
e
DO NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans By Date Plans By Notes
Fee Started Approved
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
ate Date
Permit or Approval Check ObDta ned Number By Permit or Approval Check Obtained Number By
BOILER PLUMBING
CURB OR SIDEWALK CUT ROOFING
ELEVATOR SEWER
ELECTRICAL SIGN OR BILLBOARD
FURNACE STREET GRADES
GRADING USE OF PUBLIC AREAS
OIL BURNER WRECKING
OTHER OTHER
VII. VALIDATION
Building FOR DEPARTMENT USE ONLY
Permit number
Building ^\ Use Group
Permit issued 19
Building Fire Grading
Permit Fee $ Q• Live Loading
Certificate of Occupancy $ Occupancy Load
ed by:
Drain Tile $
Plan Review Fee $
TITLE
NOTES and Data — (For department use)
., � CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060 4P P__?k0 PLAN EXAMINATION AND
dd�� BUILDING PERMIT
z
IMPORTANT - Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
r` �� ZONING
I• AT (LOCATION) L 7 ��^ DISTRICT
LOCATION (NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
V1
II. TYPE AND COST OF BUILDING - All applicants complete Parts A - D
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use m
m
1 ❑ New building Residential Nonresidential
2'S<Addition(If residential, enter number 12 X One family 18 ❑ Amusement, recreational
of new housing units added, if any,
in Part D, 13) 13 Two or more family — Enter 19 ❑ Church, other religious
number of units— — — — --> 20 ❑ Industrial
3 [_-] Alteration (See 2 above)
14❑ Transient hotel, motel, 21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory — Enter number 22 Service station, repair garage
5 F-1 Wrecking (If multifamily residential, of units ——————— — -i
enter number of units in building in 15 Garage 23 ❑ Hospital, institutional
Part D, 13)
16 ❑ Carport 24❑ Office, bank, professional
6 ❑ Moving (relocation)
17 Other — Specify 25 ❑ Public utility
7 ❑ Foundation only
26 ❑ School, library, other educational
B. OWNERSHIP 27 ❑ Stores, mercantile
8;< Private (individual, corporation,
( 28 ❑ Tanks, towers
a+� �"�
nonprofit institution, etc.) ❑29 Other — Specify
9 ❑ Public (Federal, State, or
local government)
C. COST (Omit cents) Nonresidential — Describe in detail proposed use of buildings, e.g., food
O processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement................ /3o school, secondary school, college, parochial school, parking garage for,
department store, rental office building, office building at industrial plant.
To be installed but not included If use of existing building is being changed, enter proposed use.
in the above cost
a. Electrical.....................
b. Plumbing .....................
c. Heating, air conditioning..........
d. Other (elevator, etc.)............
2
11. TOTAL COST OF IMPROVEMENT $13
III. SELECTED CHARACTERISTICS OF BUILDING - For new buildings and additions, complete Parts E - L;
for wrecking, complete only Part J, for all others skip to IV.
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS /
30❑ Masonry (wall bearing) 40 Public or private company 49• Number of stories...... area, ..
31 Wood frame 41 ❑ Private (septic tank, etc.) 49. Total square feet of floor area,
all floors, based on exterior -�'x
32 Structural steel dimensions yoftQ�
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34 ❑ Other — Specify 42 Public or private company 50. Total land area, sq. ft. ...........
43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed ......................
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35 F-1 Gas ill there be central air 52. Outdoors.......................
con "oning?
36 F-1 oil L. RESIDENTIAL BUILDINGS ONLY
37 U Electricity 44 ❑ Yes 45 ❑ No 53. Number of bedrooms..............
38 ❑ Coal
39❑ Other — Specify Wil ere be an elevator? Full.../....
54. Number of
46 ❑ Yes 47 ❑ No bathrooms
Partial.......
hereby certify that the proposed, work is authorized by the owner•of record,
and i have been authorized by the owner to make this application as his
authorized agent.
1
SIGNATURE O ` AGENT`'
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19
DEPT. FILE COPY
ZO
DEPARTMENT B�U�'D �sPgCTZV�IS BUILDING ga
NORTHAMPTON9 M. 01060 PERMIT
VALIDATION
29 - 380
DATE .Tune 18. 19 PERMIT NO. 417
APPLICANT .Sp-stu"An Clut>ram ADDRESS 179 Florence RiL
(N0.) (STREET) (CONTR'S LICENSE)
q NUMBER OF
PERMIT TO Addl tf @n _(.J.�) STORY kt't'gc�1Qfj Q9r$ge ---DWELLING UNITS 1_
(TYPE OF IMPROVEMENT) N0. (PROPOSED SE)
Florence , ZONING
179
AT (LOCATION) --DISTRICT 13RA
(NO.) (STREET)
a BETWEEN AND
,(CROSS STREET) (CROSS STREET)
=� LOT
e SUBDIVISION LOT-------17--BLOCK SIZE
m
a
0 BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
O
ID
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
2
it
O
W REMARKS: —_New gArage 201 X 241
AREA OR 1300 00 FEEMIT $ 1Q.00
VOLUME ESTIMATED COST .
(CUBIC/SQUARE FEET)
j
OWNER B P
ADDRESS 179 Florence Rd., Northulptou B
(Affidavit on-reverse side of application to be completed by authorized agent of wner)